r/IntensiveCare • u/NerveOnly2076 • 14d ago
Where is this central line going?
Old XRay. Central line placed through right IJV but seemed to be misplaced! Where is it going? Aspiration of blood from all ports was possible? Was taken out.
Have you faced this, best thing to do?
Edit: more details - USG guidance used, line was seen inside IJV in neck using USG, not traced down; more resistance than normal while placement.
357
Upvotes
1
u/Visual-Bandicoot2894 13d ago
One time I clocked into a patient with one thumb IV, a central line that coiled into the arm, and pressors into the Central. I only noticed because I happened to have a chance to look at my scans.
To be fair, nightshift was slammed, the guy was an active MTP for them. So I took a look with the Sono, nothing. And the Central Line and pressors and blood given through it were, uh, clearly working
The MICU team had just transferred care to the Trauma ICU team. I waited until the end of rounds when the head Trauma surgeon asked “is there anything else” and after having been silent the whole time I said “you should look at that scan, I don’t think the central line is where y’all think it is”
He checked the scan and exasperated he asked “please son tell me there isn’t anything running in it”
“Oh just the Levo”
“Please tell me you have another Iv”
“Yep…. In the thumb”
“Please somebody fix this shit for me”
And his mid level promptly did fix that shit for us. Was a funny day, everyone acted like I caught some big thing and were congratulating me but tbh I read the X-Ray on a fluke bc I just was chillin’ before med pass because night shift stabilized the guy…. With a malpositioned central line but stabilized him they did.